@article{ShibanDiemerMuelleretal.2017,
  author    = {Shiban, Youssef and Diemer, Julia and M{\"u}ller, Jana and Br{\"u}tting-Schick, Johanna and Pauli, Paul and M{\"u}hlberger, Andreas},
  title     = {Diaphragmatic breathing during virtual reality exposure therapy for aviophobia: functional coping strategy or avoidance behavior? A pilot study},
  series = {BMC Psychiatry},
  volume    = {17},
  journal   = {BMC Psychiatry},
  doi       = {10.1186/s12888-016-1181-2},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-181007},
  pages     = {10},
  year      = {2017},
  abstract  = {Background: Although there is solid evidence for the efficacy of in vivo and virtual reality (VR) exposure therapy for a specific phobia, there is a significant debate over whether techniques promoting distraction or relaxation have impairing or enhancing effects on treatment outcome. In the present pilot study, we investigated the effect of diaphragmatic breathing (DB) as a relaxation technique during VR exposure treatment. Method: Twenty-nine patients with aviophobia were randomly assigned to VR exposure treatment either with or without diaphragmatic breathing (six cycles per minute). Subjective fear ratings, heart rate and skin conductance were assessed as indicators of fear during both the exposure and the test session one week later. Results: The group that experienced VR exposure combined with diaphragmatic breathing showed a higher tendency to effectively overcome the fear of flying. Psychophysiological measures of fear decreased and self-efficacy increased in both groups with no significant difference between the groups. Conclusions: Our findings indicate that diaphragmatic breathing during VR exposure does not interfere with the treatment outcome and may even enhance treatment effects of VR exposure therapy for aviophobic patients.},
  language  = {en}
}
@article{GenheimerAndreattaAsanetal.2017,
  author    = {Genheimer, Hannah and Andreatta, Marta and Asan, Esther and Pauli, Paul},
  title     = {Reinstatement of contextual conditioned anxiety in virtual reality and the effects of transcutaneous vagus nerve stimulation in humans},
  series = {Scientific Reports},
  volume    = {7},
  journal   = {Scientific Reports},
  number    = {17886},
  doi       = {10.1038/s41598-017-18183-3},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-169892},
  year      = {2017},
  abstract  = {Since exposure therapy for anxiety disorders incorporates extinction of contextual anxiety, relapses may be due to reinstatement processes. Animal research demonstrated more stable extinction memory and less anxiety relapse due to vagus nerve stimulation (VNS). We report a valid human three-day context conditioning, extinction and return of anxiety protocol, which we used to examine effects of transcutaneous VNS (tVNS). Seventy-five healthy participants received electric stimuli (unconditioned stimuli, US) during acquisition (Day1) when guided through one virtual office (anxiety context, CTX+) but never in another (safety context, CTX-). During extinction (Day2), participants received tVNS, sham, or no stimulation and revisited both contexts without US delivery. On Day3, participants received three USs for reinstatement followed by a test phase. Successful acquisition, i.e. startle potentiation, lower valence, higher arousal, anxiety and contingency ratings in CTX+ versus CTX-, the disappearance of these effects during extinction, and successful reinstatement indicate validity of this paradigm. Interestingly, we found generalized reinstatement in startle responses and differential reinstatement in valence ratings. Altogether, our protocol serves as valid conditioning paradigm. Reinstatement effects indicate different anxiety networks underlying physiological versus verbal responses. However, tVNS did neither affect extinction nor reinstatement, which asks for validation and improvement of the stimulation protocol.},
  language  = {en}
}